Arthroscopic repair for isolated subscapularis tear: successful functional outcomes and high tendon healing rate can be expected nine years after surgery.

Autor: Galasso O; Department of Orthopaedic and Trauma Surgery, 'Magna Græcia' University, Mater Domini' University Hospital, Catanzaro, Italy., Mercurio M; Department of Orthopaedic and Trauma Surgery, 'Magna Græcia' University, Mater Domini' University Hospital, Catanzaro, Italy., Gasparini G; Department of Orthopaedic and Trauma Surgery, 'Magna Græcia' University, Mater Domini' University Hospital, Catanzaro, Italy. Electronic address: gasparini@unicz.it., Spina G; Department of Orthopaedic and Trauma Surgery, 'Magna Græcia' University, Mater Domini' University Hospital, Catanzaro, Italy., De Gori M; Department of Orthopedic and Trauma Surgery, Basso Ionio Hospital, Soverato, Italy., De Benedetto M; Division of Orthopaedic and Trauma Surgery, 'Villa Verde', Fermo, Italy; Department of Orthopaedic and Trauma Surgery, 'Villa Maria Cecilia' Hospital, Cotignola, Italy., Orlando N; Division of Orthopaedic and Trauma Surgery, 'Villa Verde', Fermo, Italy; Department of Orthopaedic and Trauma Surgery, 'Villa Maria Cecilia' Hospital, Cotignola, Italy., Castricini R; Division of Orthopaedic and Trauma Surgery, 'Villa Verde', Fermo, Italy; Department of Orthopaedic and Trauma Surgery, 'Villa Maria Cecilia' Hospital, Cotignola, Italy.
Jazyk: angličtina
Zdroj: Journal of shoulder and elbow surgery [J Shoulder Elbow Surg] 2024 Jun; Vol. 33 (6), pp. 1285-1292. Date of Electronic Publication: 2023 Nov 29.
DOI: 10.1016/j.jse.2023.10.016
Abstrakt: Background: Literature describing outcomes and integrity after isolated subscapularis (SSC) tendon repair is emerging but remains limited to a few small case series with short-term follow-up. The aim of this study was to evaluate the long-term clinical outcomes and repair integrity in patients who underwent arthroscopic repair of isolated SSC tears.
Methods: A retrospective study was conducted with the following inclusion criteria: (1) primary and elective shoulder arthroscopy for isolated SSC repair, (2) type III (a full-thickness tear in the upper two-thirds of the tendon) or IV (a complete tear without tendon retraction) SSC tear according to the Lafosse classification, and (3) a minimum 24-month follow-up. Preoperatively, the range of motion (ROM) and the Constant-Murley score (CMS) and at follow-up, the ROM, the University of California-Los Angeles (UCLA) Shoulder Rating Scale, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the CMS were evaluated; an ultrasonographic assessment of tendon healing was performed according to the Sugaya classification.
Results: The final sample consisted of 45 patients with an average age of 55 ± 9 years. After a mean follow-up time of 107 ± 54 months, the mean UCLA and DASH scores were 8.7 ± 1.3 and 42.2 ± 6.4, respectively. ROM and CMS showed statistically significant improvements (all P < .001). Before surgery, the mean CMS was 49% that of sex- and age-matched healthy individuals, and all patients showed a CMS lower than the normative data. At the final follow-up visit, the mean CMS was 94.2% that of sex- and age-matched healthy individuals, and no patients showed CMS of 30 or less. The mean increase in the CMS was 41.4 ± 9.8 points (range, 23-60 points). The ultrasonographic assessment showed SSC tendon healing in 39 (86.7%) cases; tendon retear was recorded in 5 (13.3%) cases. All scores directly correlated with the healing of the tendon. A higher postoperative DASH score was associated with male sex (P = .039, β = 5.538) and a longer follow-up period (P = .044, β = 0.001). The postoperative CMS (P < .001) and UCLA scores (P = .001) were significantly higher in patients younger than 60 years of age at surgery than in older individuals.
Conclusion: Arthroscopic repair of isolated SSC tears achieves excellent clinical and functional results at a mean of 9 years postoperatively, with a satisfactory healing rate. Better functional outcomes correlate with SSC tendon integrity and were observed in male patients and in those younger than 60 years at surgery.
(Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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